ICD-10 H59.031
Billable / Specific CCCystoid macular edema following cataract surgery, right eye
About ICD-10-CM H59.031
ICD-10-CM code H59.031 represents Cystoid macular edema following cataract surgery, right eye. This is a billable/specific code in the Eye and Adnexa chapter (block H59). The 2026 edition of ICD-10-CM H59.031 became effective on October 1, 2025.
Coding Tips for H59.031
Specialist guidance from the PayerReady Medical Coding Team. Specificity warnings, HCC capture rules, sequencing notes.
H59.031 is designated CC for MS-DRG grouping. On inpatient claims, this code can shift the DRG to the with-CC variant when documented as a present-on-admission secondary diagnosis. Hospital CDI programs flag CC opportunities during chart review. Failure to capture this code may leave 30 to 80 percent of the inpatient stay revenue unrealized.
Inpatient DRG Impact, CC
codes Cystoid macular edema following cataract surgery, right eye. As a Complication/Comorbidity (CC), this contributes to DRG severity adjustment when documented alongside the principal diagnosis.
Medicare LCD Coverage for H59.031
Local Coverage Determinations (LCDs) from CMS MACs that list H59.031 as a covered diagnosis.
Showing top 10 of 32 total . Click a CPT for full coverage scope.
Commercial Payer Coverage
Coverage policies from major commercial payers referencing H59.031.
5 Medicare
1 Aetna
CPT Codes Commonly Billed with H59.031
Procedures frequently paired with this diagnosis based on PayerReady's Dx↔Px linkage data.
We don't have CPT pairings indexed for this specific code yet. Use the CPT search above to find common procedures, or check your payer's published medical policy for code-specific guidance.
Convert H59.031 to ICD-9-CM
Per CMS General Equivalence Mappings (GEMs), useful for legacy data review and historical claim analysis.
| ICD-10 | ICD-9 | Mapping Flags |
|---|---|---|
| H59.031 | 99799 | 10000 |
Flags format (5 digits): Approximate · No Map · Combination · Scenario · Choice List. Source: CMS 2017 GEMs (final version).
Codes Adjacent To H59.031
Other codes in section H59 (Intraoperative and postprocedural complications and disorders of eye and adnexa, not elsewhere classified).
ICD-10 H59.031, Billing FAQ
Is ICD-10 code H59.031 billable? +
Yes, H59.031 is a billable ICD-10-CM code that can appear as a primary or secondary diagnosis on claims.
Is H59.031 a CC or MCC for inpatient DRG? +
Yes, this code is designated as CC. Documenting as a secondary diagnosis on inpatient claims can shift the DRG to a higher-weighted category.
What ICD-9 codes does H59.031 map to? +
Per CMS GEMs, H59.031 maps to ICD-9 codes: 99799. Useful for legacy data review and historical claim analysis.
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Reviewed by the PayerReady Medical Coding Team
Verified against the CMS 2026 code set on May 31, 2026.
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